Provider Demographics
NPI:1255354742
Name:COHN, STACEY KURTZ (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:KURTZ
Last Name:COHN
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5166
Mailing Address - Country:US
Mailing Address - Phone:703-448-2470
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW # M3400
Practice Address - Street 2:GEORGETOWN UNIVERSITY HOSPITAL, DEPT. OF NEONATOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021509M65Medicare PIN